Climate Change at the Doctor’s Office

As the climate crisis continues to impact our health, doctors and nurses are finding themselves increasingly on the frontlines. This is especially true for people who care for low income communities and communities of colour. These patients include people who work in construction, agriculture, and other fields that require strenuous labor in extreme heat. They provide support for firefighters and first responders who have been dealing with rising levels wildfire smoke, which can worsen asthma and contribute to other respiratory illnesses. Patients are increasingly being diagnosed with infectious diseases that can be spread by everything. The number of mosquitoes is increasing rapidlyFloodwaters contaminated with toxic substances. Clearer than ever is the mental trauma caused by climate change, especially among disaster workers.

For health care professionals, this means a key part of the job has become recognizing climate-related health hazards, as well as advocating for climate resiliency measures that will improve their patients’ daily lives and health outcomes. This could be anything from supporting workplace protections such as those offered by the EPA to better protect workers. Protect workers from extreme heat, smoke, and other hazards) to helping patients access energy efficiency upgrades that Reduce air pollution in affordable housing units. Record levels of Health care workers who are burned out, treating patients more holistically in these ways can only help relieve this burden that’s been exacerbated by the COVID-19 pandemic.

As a co-chair of the Climate Change Working Group, Dr. Cheryl Holder works to increase knowledge among health care providers about climate change impacts. Florida Clinicians for Climate ActionThe Medical Society Consortium on Climate and Health affiliate. She recently explained her journey to understanding how climate resilience measures are critical to improving health outcomes, as well as how it’s changed her own medical practice.

How have the health effects of climate changes been felt in your work or community?

I’d been hearing so much about it—not even health, just about the climate. I had always seen images of the polar bears and what was happening to them. And the sea level rise—there’s a tremendous amount of information on what the water’s going to do and how the buildings are going to go. But I’m here with patients, and more and more have started coming in [with climate-related health effects]. Because of this, I began seeing children with asthma. moldextreme weather conditions, and mental health issues.

It all began to come together. It is impossible to ignore the fact that global warming has occurred and that the climate has changed. Most of us are affected by the warming, especially those who live in these communities. It’s not something that is going to happen in 20 years, 30 years—it is happening now.

I understand what my patients are going though. They express it through their health, asthma, skin rashes, as well as through their kidneys. My workers are especially affected. That’s the population I care for. It brought it to my attention. I couldn’t ignore the climate and couldn’t ignore what was happening to patients’ health. We must act.

How can you approach conversations about the effects of climate change on health in the clinic, with patients and in the larger communities that you work with?

I work with folks who are marginally employed, so they’re outside and they don’t have transportation all the time. I’m in the middle of Florida. So when you’re going to a bus stop and there’s no bus shelter, you feel the heat. When you’re walking on the pavement, you feel the heat. I work with street vendors who sell produce and flower. They feel the heat.

I see the resistance to taking certain blood pressure medications like diuretics, which is a very cheap blood pressure medication for my patients’ hypertension. It works really well, but they can’t take it, because they are going to get even more dehydrated with the heat. They need to keep drinking enough fluids to continue their journey. It just doesn’t work.

So it’s easier for me in many ways to help them see that it’s getting hotter. “Yeah, but it’s always getting hot,” they tell me—but really, is it always hot at 8 o’clock in the morning? Is it hotter at night than it is now? Is your electricity bill rising?

As much as I can, I connect it for my patient so that they’ll understand it better, and I help them to take precautions and see what they can do to prevent dehydration. Little things, so they feel empowered and can continue on and keep working with some hope that it’s going to get better. They also see that they can advocate to make changes. So it’s a tiny baby step forward with folks who really don’t have the power to change it—immediately—but they do over time.

What are some ways that medical professionals can advocate for workers and others from the climate-related impacts to their health?

As clinicians, we do have to recognize that if our ultimate goal is to improve health outcomes—and that’s what we said we went to medical school for—then advocacy is a natural part of what we do. Because that’s the only way that we can truly improve the health of the patient that we are caring for.

We [clinicians]You must recognize the problems in our society. Sexism, racism, and other -isms—they’re all part of what brings you to power. To use our voices to change the world and improve society. So it’s being realistic and saying, “Yes, we know we have a lot more power as physicians” and to use it in a positive way, because we have to do this as a part of treating our patients. We can no longer think we can just give them a prescription and they’ll go home and get well. It just doesn’t work that way. Physicians have a huge responsibility—but I don’t see it as a responsibility as much as it is a part of providing health care.

And if that’s what we said we’re going to do—health care—then how do we get our team to do the work and find better ways of listening to our patients?

I tell doctors that you had planned to provide care. How do you do it when your office gets flooded or all your patients’ homes get flooded? Or when you have so many heat advisories or so many changes. Clinicians need to wake up. Clinicians are the ones who feel the brunt in climate change, just like the coronavirus.

How can physicians better integrate patient stories and social history–related information in order to help their patients adapt to climate change and improve their health outcomes at the same time?

It’s all about social determinants of our health. I have a patient with hypertension, she has COPD, and in the previous way of looking at how we teach students, her case would be “70-year-old woman, noncompliant, using her inhalers, needing refills earlier, COPD exacerbation.” Totally physiologic. It is possible that she uses her inhalers excessively and doesn’t follow instructions. They would likely only teach her how she holds her inhaler and how to use it properly. Rather than framing it as “70-year-old woman, in an old building with limited resources, with a warming daytime and nighttime temperature, an increase in allergens and pollution in her home, triggering her asthma and COPD and overutilization of medication.”

You can reframe the situation to look at the real causes of her illness and then add these factors. It pushes the clinician to take it a little bit further: “How do I then address some of these Social issues which are important?” In my situation, I had to send her to the social worker. I filled out the form to get her some benefits. I also tried to get extra inhalers and a better situation for her house, and that’s where the social worker came in. Because if we don’t get a better housing situation, and help her with her bills, her health is going to constantly deteriorate, which will lead to lots of hospitalizations and an earlier death.

It helps if you understand that social history is a part of diagnosing a patient. And you have to address those, otherwise your patient won’t improve.

How can you maintain your enthusiasm and keep building momentum without falling prey to climate anxiety?

We’ve had hundreds of years of successes in medicine. Look at all the antibiotics and the mRNA technology. So there’s a lot of history. This gives me hope that this can be overcome. So why should the future look any different? History has shown me that climate solutions are not possible if they are not framed in. A way that helps the vulnerableWe will get there eventually, but with a lot loss.

If we want to see the world differently, we need to examine how we value people. How can we not just talk, but make it a responsibility to work together across all cultures and the globe? I’m optimistic that history tells us that we shall overcome. Climate is the final thing that’s going to push us to work together. We just can’t win any other way.

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